Tuesday, December 29, 2015

Antipsychotic discontinuation following functional recovery in patients after a first episode of psychosis (FEP) appears to be associated with a very high rate of relapse compared with those who maintain antipsychotic treatment, according to a report that appears in The Journal of Clinical Psychiatry.

Moreover, the time to relapse was faster for those who discontinued medication compared with those who relapsed on maintenance treatment, say researchers.

“In clinical practice, physicians very often face the dilemma of discontinuing or maintaining antipsychotics in those patients who have fully recovered from their initial episode of psychosis,” they wrote. “In those individuals who are willing to discontinue medication, a planned medication withdrawal strategy with follow-up should be established to prevent unrestrained treatment disengagement. Clinicians should provide accurate information to patients and relatives concerning the risks and benefits of withdrawing medication.”

Study participants were drawn from an ongoing longitudinal intervention study for FEP in Spain. Inclusion criteria for the study were receiving 18 months of treatment with antipsychotics, meeting clinical remission criteria for 12 months and functional recovery criteria for six months, and being stabilized on the lowest antipsychotic dose for three months. A total of 46 individuals opted to discontinue medication, and 22 remained on maintenance medication; the primary outcome measures were relapse rate at 18 and 36 months and time to relapse.

In the discontinuation group, 31 patients (27 relapses and four cases of deterioration in symptoms) relapsed. In contrast, among patients in the maintenance group, just seven patients relapsed over the three-year period. The average time to relapse in the maintenance group was 608 days compared with 209 days for those who relapsed in the discontinuation group.

“[T]he rate of symptom recurrence in functionally recovered FEP patients following the self-elected discontinuation of treatment is extremely high,” the researchers state. “Relapsed individuals had a greater severity of symptoms and lower functionality [during the three-year follow-up period] compared with those patients who did not relapse during the follow-up.”

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